Nurses and midwives at breaking point...

Let us all face the facts. Nursing shortage has reached unprecedented levels in our country. At the present time, Malta is suffering from a growing disparity between supply and demand in the case of nurses. This disparity is leading to the severe nursing shortage and health care crisis. This nursing shortage is classified as more severe and presents a real threat to the nation's health. It would be difficult to pinpoint each individual contributing factor that has impacted the nursing shortage over the years. However, there are a few main factors that should be examined in order to better understand the reasons behind this dramatic shortage.

Nurses and nursing are part of an evolving health system. Changes in society (demographics, economics, environment, education, and politics) affect the nurses' personal and professional lives and influence the way they deliver care. The aging nurse workforce and shrinking student pool in Malta are contributing to a critical nursing shortage threatening patient's access to quality care.

The nurses' shortage is one of the main factors contributing to stress. According to the International Labour Organisation (ILO) nursing is, by its very nature, a "stressful" profession. ILO observed that: "Everyday the nurse confronts stark suffering, grief and death as few other people do. Many nursing tasks are mundane and unrewarding. Many are, by normal standards, distasteful and disgusting. Others are often degrading; some are simply frightening".

There was a period in this country where the health authorities used to claim that the country is producing sufficient nurses and the concern of a shortage of nurses does not exist. This had become more evident when the stipend of the student nurses was slashed from a minimum wage salary to the basic lowest stipend of just Lm32 per month. MUMN has always claimed this nurse's shortage but was completely ignored or was sometimes criticised of over exaggerating such an issue.

What are the effects of the nurses' shortage?

The nurses' shortage has moved to a stage where the long-standing stress experienced at the various government hospitals is now causing burnout to nurses and midwives. These shortages have led to poor working conditions. Nurses working in government hospitals, such as Mount Carmel Hospital and St Vincent de Paul's Residence, cannot avail of their legitimate leave. In some cases, nurses had their leave cancelled (due to lack of staff replacement) for nine consecutive times. I doubt whether this happens in any other working place within the whole public sector.

At St Luke's Hospital, stress and burnout are being caused by other aspects. Heavy workloads on the depleted staff have taken their toll. Wards, which according to the manpower plan are designated for 31 patients, are being conditioned to cater for 45 to 50 patients for months. The Health Division seems to be impotent in front of this long standing problem.

Retention of current nurses and midwives within the health service is also proving to be challenging. Poor working conditions, lack of job satisfaction, career progression and lack of appreciation are some of the issues constraining nurses and midwives to withdraw from the profession.

To address this problem, my union has embarked on improving the working conditions of all nurses and midwives. MUMN has looked at role models in the countries of the European Union and developed a package tailored to Maltese nurses and midwives. The nursing profession has been deprived from the dignity it deserves. Warrants have been denied to nurses even though, through the Health Care Professions Act, nurses have already become recognised as a professional body that can work autonomously. Such an issue was included in the Malta Labour Party's manifesto. Now MUMN is pursing such a matter with the central government and discussions are well under way. Hopefully, it will not take ages to finalise the talks.

Statistics show that, taking into consideration only surgical patients, hospitals with higher percentages of qualified nurses have higher surgical survival rates. In fact, these statistics reveal that a 10 per cent increase in the level of qualified registered nurses reduced the risk of patients' death by as much as five per cent. This is just one example of the impact nurses have on patient's healthcare.

When addressing the nurses' shortage, the first issue to consider is what weight does the government give to the problem, followed by the fact as to how seriously it intends to address such a problem. This depends on the government tackling issues that are hindering job satisfaction and working conditions.

In the coming weeks, MUMN is hoping to finalise a package of incentives to deal with such issues. Staff retention, a safer and friendlier environment at state hospitals are matters the government and the Health Division cannot afford to ignore.

Investing heavily in new hospitals is not a guarantee of better service to patients. MUMN has always insisted that investment in the primary health care settings will serve to reduce the number of beds in Mater Dei Hospital and the cost of the health care services on the Maltese islands. It is therefore a great pity that such a service has been shelved or not further developed even in a scenario of retaining the aging population within the community.

The World Health Organisation believes that nursing/midwifery is the backbone of health care. Improving patient care is about ensuring that the nursing voice is listened and heard at every level - from the bedside to the board room. Nurses and midwives will stand together and give each other support when needed. Other professions are always welcome to join in this multi-disciplinary effort in the patient's interest. For the patient's benefit, nurses and midwives must learn from the past and look to the future. We will work together and care together.

(The term nurses and nursing applies also to midwives and midwifery.)

Mr Pace is president of the Malta Union of Midwives and Nurses.